Provider Demographics
NPI:1053398826
Name:MANZELLA FAMILY HEALTHCARE PC
Entity type:Organization
Organization Name:MANZELLA FAMILY HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANZELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-325-8393
Mailing Address - Street 1:1353 STATE ROUTE 903
Mailing Address - Street 2:
Mailing Address - City:JIM THORPE
Mailing Address - State:PA
Mailing Address - Zip Code:18229-2734
Mailing Address - Country:US
Mailing Address - Phone:570-325-8393
Mailing Address - Fax:570-325-8029
Practice Address - Street 1:1353 STATE ROUTE 903
Practice Address - Street 2:
Practice Address - City:JIM THORPE
Practice Address - State:PA
Practice Address - Zip Code:18229-2734
Practice Address - Country:US
Practice Address - Phone:570-325-8393
Practice Address - Fax:570-325-8029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1753980OtherBLUE CROSS/ BLUE SHIELD
PA50056259OtherCAPITAL BLUE CROSS
PA1753980OtherBLUE CROSS/ BLUE SHIELD